Portal Pressure Lowering Effect Of Angiotensin Ⅱ Receptor Antagonists In Cirrhotic Patients:a Meta-Analysis

Background:Recent studies demonstrated that the plasma levels of angiotensin Ⅱ was significantly increased in patients with liver cirrhosis. These findings provided a rationale for the use of angiotensin Ⅱ receptor blockers (ARBs) in the management of portal hypertension.Objective:To investigate the effects of Angiotensin Ⅱ receptor Blockers(ARBs) versus those of propranolol, a non-selective β-blocker(NSSB) on portal hemodynamics in cirrhotic portal hypertension.Methods:The Cochrane library, Pub-Med, Embase, Medline, Embase.com, BMJ Best Practice, Elsevier, Web of science, Springer, CNKI, SSCI, Wan Fang and CBM were searched (January1999-Decemberl 2013) to identify RCTs that met our inclusion criteria and evaluated the Portal Pressure Lowering Effect of Angiotensin Ⅱ Receptor Antagonists in Cirrhotic Patients. Methodological quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. The observed outcomes included:Hepatic Venous Pressure Gradient (HVPG); Wedged Hepatic Venous Pressure(WHVP); mean arterial blood pressure (MABP); heart rate(Hr); total bilirubin (Tbil);Serum creatinine (Cr). A meta-analysis was performed using Revman 5.2 software.Results:Ten publications were included (n=381). One study was counted twice.Five studies compared ARBs to propranolol while the others compared ARBs to placebo. Quality assessment of articles was performed using Jadad score. Results showed that there was no difference between ARB and control group on reduction of HVPG as overall effect size is 1.04,95%CI (-0.26,2.33) with p value above 0.05. Analysis of heart rate(HR) showed that ARB has smaller effect on heart rate than that of placebo because overall effect size is -10.34, 95%CI (-16.64,-3.64). Analysis of effect on Wedged Hepatic Venous Pressure(WHVP) showed no difference between control and intervention group, as overall effect is 1.35 with 95%CI (-0.31,3.01). For Mean Arterial Blood Pressure(MABP) results showed that ARB has smaller effect than that of control group, as overall effect size is -7.37 (-13.12,-1.62). Total bilirubin (Tbil) marker analysis showed that ARB has larger effect than the control group. There was no statistical significant difference between ARB and placebo group on Cr (Creatinine).Conclusion:ARBs and propranolol have the same effect on HPVG and WHVP showing a reduction of portal pressure in patients with portal hypertension and cirrhosis. Hence, Angiotensin II receptor blockers can be considered as an alternative clinical approach for the treatment of portal hypertension.